Medial Canthus Research Articles

Reconstruction of a Complex Medial Canthal Defect.

Reconstruction of a Complex Medial Canthal Defect.

The Gliding Browlift: An Analysis of Outcomes and Maintenance of Lift in a Single Surgeon's Practice.

Efforts in browlifting longevity, desire for minimally invasive procedures, patient individualization, and minimization of complications led to the development of the gliding brow lift (GBL). The GBL has proven to be a successful, minimally invasive technique targeting brow elevation in combination with the hemostatic net. To evaluate maintenance of cutaneous brow elevation with the GBL technique at specific post-operative time points. A retrospective review was conducted of 63 patients (59 females; 4 males) who underwent a GBL by the senior author (JCG) between 2019 and 2022 for co-morbidities, maintenance of brow lift, and incidence of complications at four post-operative time points: 3, 6, 9, and 12 months. Pre- and postoperative photographs were analyzed at four anatomic locations: supraorbital rim, lateral canthus, mid pupil, and medial canthus. The cohort consisted of 59 female-only patients; male patients were excluded due to small sample size. The average age of 62.8 years old (SD ±7.01) and a mean BMI of 24. Only one patient required return to the operating room for hematoma evacuation; this was a result of a concomitant rhytidectomy and not involving the brow. All locations maintained a statistically significant lift (p<0.01). The most significant lift was at the lateral canthus (3.09 mm) and tail of the brow (2.74 mm) at 1 year post-operatively. The GBL is a successful innovation in aesthetic brow surgery. Depending on patient needs, it is an excellent choice for selective and long-term elevation of the lateral brow.

Surgical correction of medial canthal widening associated with aging: two case reports

Medial canthal widening due to aging is a frequent concern among elderly individuals, often resulting in cosmetic dissatisfaction. This condition commonly involves caruncle exposure and elongation of the medial canthus, sometimes requiring surgical intervention. While medial epicanthoplasty is commonly used to address medial canthal deformities, age-related changes call for a modified approach to optimize aesthetic results. We present two cases of elderly patients whose medial canthal widening was corrected using a modified V-Y advancement flap combined with medial canthal tendon tightening. This technique involves elevating a V-flap and suturing the pretarsal orbicularis oculi muscle and medial canthal tendon to restore medial canthal contour. In one case, an 85-year-old man with unilateral caruncle exposure experienced marked cosmetic improvement post-surgery. In the second case, a 71-year-old woman with bilateral medial canthal widening also reported significant improvement. Both patients had no complications and expressed satisfaction with their postoperative appearance. This surgical approach effectively reduced caruncle exposure and enhanced eye shape with no recurrence or wound healing problems. Medial canthal widening from aging can be successfully treated with a V-Y advancement flap and medial canthal tendon tightening, offering elderly patients a dependable solution with favorable cosmetic results.

Reconstructive Techniques Following Malignant Eyelid Tumour Excision-Our Experience.

Background: Malignant eyelid tumours present a considerable challenge in the field of ophthalmic oncology, necessitating a combination of precision oncological care and meticulous reconstruction to ensure the preservation of eyelid functionality and the maintenance of facial aesthetics. Method: This study presents a review of the outcomes of 167 patients who underwent eyelid reconstruction following the excision of primary non-melanocytic malignant tumours. The choice of reconstruction technique was dependent on a number of factors, including the stage of the tumour, its location, and the characteristics of the patient. The most commonly used techniques included regional flaps, local flaps, and skin grafts. The most frequently employed reconstruction techniques were forehead flaps (59 cases), simple excisions (38 cases), and Mustarde cheek flaps (16 cases). Result: The postoperative complications, including ectropion, epiphora, and flap necrosis, were recorded. However, no significant correlation was found between the risk of complications and either the location of the tumour or the reconstruction method employed. Despite the complexity of medial canthal and lower eyelid reconstruction, satisfactory aesthetic and functional outcomes were generally achieved. Conclusions: This study emphasises the importance of individualised surgical planning, highlighting the advantages and limitations of various techniques to optimise both the functional and aesthetic results.

Interstitial brachytherapy for periocular nonmelanoma skin cancers: Impact on organ and function preservation

PurposeTo study the local control, toxicity, organ and functional preservation and cosmetic outcomes after interstitial brachytherapy for periocular nonmelanoma skin cancers. Methods and MaterialsPatients with skin cancers of upper and lower eyelid, medial and lateral canthus and the infra-orbital region treated with high dose rate (HDR) interstitial brachytherapy (ISBT) using 192-Iridium (192Ir) between December 2010 and July 2022 were included and data collected from a prospectively maintained database. Local control, survival outcomes, acute and late RTOG toxicity, functional and cosmetic outcomes were analysed. ResultsSixteen patients were included. Nine patients had lower eyelid tumors, 5 patients had tumors in canthi and two patients had skin tumor in the infra-orbital region. The median dose for definitive ISBT was 49 Gy in 14 fractions. After a median follow up of 73 months, all patients treated with definitive and adjuvant ISBT were locally controlled. Three of the four patients who received salvage ISBT for post-surgical failure had local recurrences and all were effectively managed with salvage re-surgery. Of the two deaths, none were disease related. Organ and function preservation was achieved in 15 (93.7 %) and 13 (81.2 %), respectively, with one patient being lost to follow up. Excellent, good, fair and poor cosmesis was seen in 6 (40 %) patients, 6 (40 %) patients, 2 (14 %) patients and 1(6 %) patient, respectively. ConclusionHDR-ISBT was safe and effective for skin tumors around the eye and resulted in excellent local control and survival outcomes preserving organ and function in majority of patients with good-excellent cosmesis.

Comparative fluorophotometric evaluation of the ocular surface retention time of cross-linked and linear hyaluronic acid ocular eye drops on healthy dogs.

Evaluate and compare the retention time on the canine ocular surface of crosslinked hyaluronic acid (X-HA), linear hyaluronic acid (L-HA) and saline solution using fluorescent compounds (fluorescein sodium salt, Alexa Fluor 488 cadaverine and Alexa Fluor 488 maleimide). 0.9% saline solution (SAL) was combined with fluorescein sodium salt. X-HA and L-HA were covalently modified using Alexa Fluor 488 reactive moieties. Eye drops were applied to 70 eyes of 35 dogs that were previously assessed and determined to have a normal ocular surface. Employing a blue light filter (450-490nm), digital images were captured from instillation to 180min. Images were analyzed to assess the percent of the total ocular area covered with green fluorescence at various time points. X-HA exhibited a dual phase behavior: A broad microgel coverage first, followed by accumulation in tear film meniscus and medial canthus in the second phase, remaining in contact with the ocular surface up to 180min. Coverage with L-HA and SAL eye drops quickly migrated to the tear meniscus. No traces of the fluorescent compounds were observed by 45min in eyes treated with SAL solution compound and, by 120min, eyes treated with L-HA. X-HA exhibited a significantly increased ocular surface contact time with the ocular surface compared with L-HA and SAL. Not only could this indicate extended lubrication time but also supports the potential use of this compound as a method for topical sustained-release drug application.

A case of adnexal cutaneous leishmaniasis in Washington DC

PurposeTo report a rare non-endemic case of Leishmania aethiopica in Washington DC.Case reportA 68-year-old female presented for a routine examination with a complaint of right upper eyelid lesions for the past 5 months. On examination, a cluster of elevated and erythematous lesions extending from the medial canthus to the brow area of the right eye were seen. Initial treatment with Valtrex based on a suspected viral etiology failed. Although a biopsy was recommended at this time, the patient declined, and subsequent workup included nasolacrimal duct irrigation, blood work to rule out autoimmune etiology, a course of doxycycline, and an MRI, which yielded no improvement. Upon progression of the lesions into persistent plaques on the eyelids, a punch biopsy was performed, confirming leishmaniasis. The patient was then started on a 28-day course of oral miltefosine which led to complete resolution of her symptoms.ConclusionThis case underlines the importance of a broad differential including non-endemic diseases, particularly in urban areas with frequent patient travel. Furthermore, the delayed punch biopsy in this case highlights the importance of patient counseling to ensure prompt diagnosis and treatment.

Reconstruction of a Large Right Medial Canthus Defect.

Reconstruction of a Large Right Medial Canthus Defect.

Enhancing stress assessment in sledge reindeer (Rangifer tarandus): a pilot study on infrared thermal imaging and its opportunities for advancement as a welfare assessment tool

Measuring immediate physiological stress responses in animals can be challenging; saliva and blood sampling, while invasive, may also generate confounding stress responses, and equipping animals with heart rate sensors is not always feasible. Nevertheless, emerging technologies offer a non-invasive and contactless method to measure additional body surface temperature changes induced by acute stress, using infrared thermal measurement of the eye caruncle region. Contactless temperature measurement has the potential to assess the emotional state of animals affected by human physical contact. Reindeer, being highly sensitive to touch and naturally avoiding physical contact, exemplify this case. With growing interest in safari tours involving sledging reindeer, there is a need to investigate how these animals are affected by human interactions and how they adapt to daily close contact. In this pilot experiment, we evaluated the efficacy of thermal imaging in measuring medial canthus temperature fluctuations in non-habituated sledging reindeer while being petted by unfamiliar humans. Our findings support the hypothesis that medial canthus temperature significantly decreases during petting and increases once the interaction ceases, aligning with established stress response patterns found in the literature. This pilot experiment underscores the potential of infrared thermal imaging for non-invasively monitoring physiological responses to stress in tamed reindeer. Moreover, it sets the foundation for refining methodologies and experimental designs using infrared thermal imaging in animal welfare research.

Peribulbar Block for Cataract Surgery in Patient with Nystagmus and Chronic Kidney Disease

Background: Management of presenile cataracts with nystagmus and chronic kidney (CKD) disease is a separate problem in anesthetic procedures. The risk of anesthesia in patients with chronic kidney disease is accumulation of nephrotoxic metabolites, unstable hemodynamic during intraoperative, and fluid overload.Case: A 43-year-old man with a diagnosis of immature presenile cataract with nystagmus and comorbid CKD was planned for phacoemulsification and intraocular lens. The anesthetic technique used was regional anesthesia with peribulbar block. Site injections in the inferotemporal and medial canthus with local anesthetic drugs levobupivacaine 0.5% 5 ml and lidocaine 2% 3 ml.Discussion: Combination of peribulbar block and mild sedation provides effective analgesic and anxiolytic effects. Peribulbar blocks in nystagmus besides sensory blocks can also block motoric function so that the position of the eyeball is in center.Conclusion: The peribulbar blockade anesthetic technique can be considered as an alternative safe anesthetic technique for cataract surgery with nystagmus and CKD.

Repair of a Defect Involving the Glabella, Nasal Root, and Medial Canthi.

Repair of a Defect Involving the Glabella, Nasal Root, and Medial Canthi.

Sclerosing Perineurioma of the Orbit.

A 7-week-old boy presented to pediatric ophthalmology with a mass inferior to the medial canthus of the OS that was first noticed on day 3 of life. Crigler massages, warm compresses, and moxifloxacin HCl drops were administered without resolution of symptoms. Probing and irrigation for a presumed dacryocystocele were performed, but the nasolacrimal system was patent, and the mass persisted after the procedure. Oculoplastics was consulted for further evaluation and management. On exam, the tear lake was normal, there was no discharge to palpation of either lacrimal sac, and there was no erythema. An MRI was obtained that showed a mass with nonspecific features abutting the lacrimal sac. A gross total resection of the mass was performed, and it was sent for histopathologic evaluation. Pathology results yielded a diagnosis of sclerosing perineurioma, a rare soft tissue tumor previously unreported in the orbit.

Repair of a medial canthal defect

An 87-year-old man presented for treatment of a histology-proven basal cell carcinoma involving the left medial canthus. The lesion was successfully resected with adequate margins under local anaesthesia and resulted in a defect measuring 2 x 1.5 cm. How would you repair this defect?

Quantitative orbital tightening for pain assessment using machine learning with DeepLabCut

Pain assessment in animal models is essential for understanding mechanisms underlying pathological pain and developing effective pain medicine. The grimace scale (GS), facial expression features in pain such as orbital tightening (OT), is a valuable measure for assessing pain in animal models. However, the classical grimace scale for pain assessment is labor-intensive, subject to subjectivity and inconsistency, and is not a quantitative measure. In the present study, we utilized machine learning with DeepLabCut to annotate the superior and inferior eyelid margins and the medial and lateral canthus of the eyes in animals’ video images. Based on the annotation, we quantified the eyelid distance and palpebral fissure width of the animals’ eyes so that the degree of OT in animals with pain could be measured and described quantitatively. We established criteria for the inclusion and exclusion of the annotated images for quantifying OT, and validated our quantitative grimace scale (qGS) in the mice with pain caused by capsaicin injections in the orofacial or hindpaw regions, the Nav1.8-ChR2 mice following orofacial noxious stimulation with laser light, and the oxaliplatin-treated mice following tactile stimulation with a von Frey filament. We showed that both the eyelid distance and the palpebral fissure width were shortened significantly in the animals in pain compared to the control animals without nociceptive stimulation. Collectively, the present study has established a quantitative orbital tightening for pain assessment in mice using DeepLabCut, providing a new tool for pain assessment in preclinical studies with mice.

Posterior medial canthal thermoplasty in facial palsy: A simplified technique

Abstract Purpose: The purpose of this study was to describe a new, simple, quick, reproducible, and minimally invasive surgical technique for medial canthal tendon (MCT) dehiscence and deformity in patients with facial palsy. Methods: A retrospective study of 10 patients having medial ectropion and MCT laxity in patients with facial palsy was included in the study. All patients underwent the simplified technique of posterior medial canthal thermoplasty and anchorage with 6/0 Vicryl. Ancillary procedures such as lateral tarsal strip, lower lid spacer, suborbicularis oculi fat lift, upper lid blepharotomy, and mullerectomy were also performed where warranted as a holistic treatment approach. Results: The study cohort included 10 patients. All patients had satisfactory outcomes concerning medial canthus position and lid-to-globe apposition. 9/10 patients had satisfactory punctum alignment. Conclusions: This technique is a safe alternate and reproducible procedure compared to the conventional open technique of anchoring the lid to the posterior lacrimal crest which is a challenging procedure even in experienced hands.

Eye Temperature Measured with Infrared Thermography to Assess Stress Responses to Road Transport in Horses.

The aim of the present study was to investigate eye temperature modifications after road transport in athletic horses habituated to travel. Eight adult Italian saddle horses traveled 100 km and, two weeks later, 300 km. Eye temperature (ET), rectal temperature (RT) and serum cortisol concentration were assessed before (T1), after (T2) and 60 min (T3) after the road transport. ET was evaluated with infrared thermography (IRT) in three regions of interest: EL1 (medial canthus), EL2 (central cornea) and EL3 (lateral canthus). Two-way analysis of variance (ANOVA) for repeated measures showed statistically higher values at T2 and T3 for EL1 (p < 0.01), EL2 (p < 0.01) and EL3 (p < 0.01) following the 100 km journey. RT (p < 0.01) showed higher values at T2 and T3 after the 100 km journey and higher values at T2 (p < 0.01) following the 300 km journey. ET values were positively correlated with RT at T1, T2 and T3 following the 100 km journey and at T2 following the 300 km journey and positively correlated with serum cortisol concentration at T1, T2 and T3 following the 100 km journey and at T2 and T3 following the 300 km journey. Eye temperature monitoring with IRT allows quick and practical strategies to monitor an animal's physiological state and welfare during daily activities.

Endoscopy-assisted medial canthus incision for olfactory neuroblastoma: a case report

Sinonasal malignant tumors are a group of uncommon malignancies that account for less than 1% of all tumors. These tumors often involve the maxillary sinus and nasal cavity, with less cumulative incidence in the ethmoidal sinus, sphenoidal sinus, and frontal sinus. The lack of consensus on the management of sinonasal malignancies is due to their rarity, diagnostic challenges, and the heterogeneity of treatments. In this paper, we present a case of endoscopic-assisted medial canthus incision combined with radiotherapy in the treatment of sinonasal malignant tumors, with the aim of providing valuable insights to clinicians on the management of these tumors.

How We Do It: Medial Canthal Repair via Double V to Y Advancement Flap.

How We Do It: Medial Canthal Repair via Double V to Y Advancement Flap.

OSteosarcoma of Ethmoid Sinus-A Rare Entity.

Osteogenic sarcoma of the Craniofacial region are uncommon.They have been mainly reported in the mandible and the maxilla, Primary osteosarcoma arising from ethmoid sinus is an extremely rare condition. We report a case of 34 year old male, presented with gradually increasing swelling over the right medial canthus with history of double vision for one year. Clinically we thought it was a mucous retention cyst in the ethmoid area. After doing Contrast enhanced CT, we proceeded with transnasal endoscopic removal of the cyst. Histopathological examination of the specimen surprisingly turned out to be a low grade Osteogenic sarcoma. Patient was treated with adjuvant chemotherapy.

A REPERTOIRE OF ACUTE DACRYOCYSTITIS

Background: Clinical features of acute dacryocystitis comprise of three stages- stage of cellulitis, lacrimal abscess and fistula formation. Infective odontogenic focus is one of the known etiologies for acute dacryocystitis. Pre-septal cellulitis is the most common presentation associated with epiphora. Tenacious inflammation of sac or distal nasolacrimal duct obstruction can result in a lacrimal abscess. Unattended abscess may consequently form a fistula. Acute dacryocystitis rarely can get complicated to cause orbital cellulitis overstriding the anatomic barriers. Case Presentation: Case1: A 72/F complained of toothache since a week, followed by diffuse swelling below lower eyelid, pain and discharge near medial canthus. The case was diagnosed as acute dacryocystitis with pre-septal cellulitis due to apical abscess of right maxillary molar which was visualised on orthopantomogram. Case2: A 36/M presented with mild pre-septal cellulitis and lacrimal abscess. Case3: A 79/M presented with diminution of vision, pain and inability to move the right eye. He had history of watering for8 years. He was diagnosed to have orbital cellulitis with fistula secondary to acute on chronic dacryocystitis. Discussion: Case 1: Symptoms resolved spontaneously with emergency access opening of right first maxillary molar and systemic intravenous broad-spectrum antibiotics. She further underwent dacryocystectomy with fistulectomy. Case 2: Lacrimal abscess was managed with incision and drainage followed by dacryocystorhinostomy. Case 3: Orbital cellulitis was managed with broad-spectrum intravenous antibiotics. Dacryocystectomy with fistulectomy was performed after the eye was quiet. Conclusion: Presentation of dacryocystitis can have variable causes hence proper history and addressing underlying cause at the earliest can help in early resolution. Aggressive management of complications can help in steady subsidence without progression.